The operation-November 1

On Tuesday November 1, Ashton underwent:

a single-patch repair of the complete atrioventricular canal defect;

division of the anterior bridging leaflets, with re-suspension, of the mitral and tricuspid components, to the pericardial patch (or refashioning of the existing components of the mitral and tricuspid valves, using material from the pericardium);

Reed annuloplasty of the mitral valve (or repair of the opening of the mitral valve);

closure of the mitral valve cleft;

pulmonary valvotomy (or enlargement of the pulmonary valve opening);

excision of the extensive parietal muscle bundles within the right ventricle; and

TABLE 8.5: Persons involved in the operation on Ashton Feakes, November 1, 1994

OR team member

Persons involved

Surgeon

J. Odim

Surgical assistant

B.J. Hancock

Anaesthetists

H. Reimer, J. Doer (resident)

Scrub nurses

C. Youngson, C. McGilton

Circulating nurses

B. Zulak, C. Weber, K. Cox

Perfusionists

M. Maas, D. Smith

The myocardial protection used was moderate hypothermia and intermittent cold blood cardioplegia.

TABLE 8.6: Length of phases of the operation on Ashton Feakes, November 1, 1994

Phase of the operation

Time taken

Induction

1 hour 47 minutes

Bypass

3 hours 21 minutes

Aortic cross-clamp

1 hour 57 minutes

Total surgical time

6 hours 20 minutes

Total operating-room time

8 hours 22 minutes

Odim testified that in his opinion, the repair in Ashton's case went very well. The other participants in the operation raised no issues about this procedure. However, Soder said that a procedure of this length would give him some anxiety.

During surgery Ashton experienced problems with heart block that continued during his post-operative treatment. He had third-degree heart block during the closure of his chest, which required cardiac pacing.

Aside from the fact that withdrawal from bypass required substantial doses of inotropes, Cornel concluded that the "surgery appears to have been otherwise uneventful. Intraoperative pressure recordings were consistent with a satisfactory repair. The pulmonary artery pressure was elevated but the left atrial pressure and central venous pressure were within expected range." (Exhibit 353, page 59) In their joint report, Cornel and Duncan noted that the patches appeared to be intact and appropriately placed. In his testimony, Dr. Walter Duncan said, "I think it was well done. This is a difficult repair, I think his patches were intact, his valves looked okay, his pressures were perfect." (Evidence, page 41,451)